Psychological Medicine, 1993, 23, 87-91.

Copyright © 1993 Cambridge University Press

Working memory in clinical depression: an

experimental study
SHELLEY CHANNON,' JANE E. BAKER AND MARY M. ROBERTSON
From the Department of Academic Psychiatry, University College and Middlesex School of Medicine,
London

SYNOPSIS This study compared clinically depressed subjects with normal controls on a range of
working memory tasks. The findings suggested the articulatory loop and visuospatial sketch pad
components of working memory to be unimpaired in depression. On a range of clinical tasks likely
to involve central executive function, depressed subjects showed impairment only on some tasks.

demands on attentional resources, or where

INTRODUCTION
Empirical research with both dysphoric and
clinically depressed subjects has demonstrated
convincingly that depression is associated with
deficits in aspects of long-term memory (for a
review see Williams el al. 1988). Clinical ex-
perience suggests that depressed patients also
report problems with attention and concen-
tration, although this has received less con-
sideration by researchers. Some studies have
been carried out, but not always in the context
of a clearcut theoretical framework.
The model of working memory proposed by
Baddeley & Hitch (1974) provides a theoretical
framework which allows specific predictions to
be made. They postulated a central executive, a
processor which allocates attentional resources
and mediates problem-solving and decision-
making, and two subordinate systems, the
articulatory loop and the visuospatial sketch
pad. The supervisory attentional system postu-
lated by Norman & Shallice (e.g. Shallice, 1988)
is assumed to be similar in function to the
central executive (Baddeley, 1988).
Theoretical accounts of the effects of de-
pression on cognitive function have commonly
related these to deficient allocation of attentional
resources (e.g. Ellis & Ashbrook, 1988; Hertel &
Hardin, 1990). Such models contend that de-
pressive deficits occur in tasks which make high
1
Address for correspondence: Dr S. Channon, Wolfson Building,
Middlesex Hospital, Mortimer Street, London WIN 8AA.
87
performance can be improved by active encoding
strategies. In terms of the Baddeley & Hitch
(1974) working memory model, deficient al-
location of processing resources associated with
depression might be expected to reduce the
capacity of the central executive, but the
relatively passive processing of the articulatory
loop and visuospatial sketch pad should not be
affected.
In the following study, these predictions were
investigated by comparing clinically depressed
subjects with normal controls on a range of
tasks selected to involve aspects of working
memory. The articulatory loop was studied
using tasks taken directly from the working
memory research, while the other measures were
selected because of their widespread use in
clinical practice.
METHOD
Subjects
DSM-III-R criteria (American Psychiatric As-
sociation, 1987) were used to select right-handed
subjects who reached diagnostic criteria for
Major Depression, and had no history of alcohol
or drug abuse, physical illness or other psy-
chiatric disorder. The depressed group com-
prised 24 subjects (7M, 17F) of mean age 39-29
(s.D. 11-09), 15 of whom were prescribed anti-
depressant medication at the time of testing.
Similar exclusion criteria were used to select 21
non-depressed control subjects (6M, 15F), of
 S. Channon and others
mean age 3900 (S.D. 13-94). The t test showed
that the groups did not differ significantly in
age; nor did they differ significantly in sex ratio
using the x2 test.
Clinical measures
All subjects underwent a clinical interview.
Depression was assessed using the Hamilton
Depression Scale (Hamilton, 1967) and the Beck
Depression Inventory (Beck et al. 1961). In
addition, the State-Trait Anxiety Inventory
(Spielberger et al. 1970) and the Ley ton Obses-
sional Inventory (Snowdon, 1980) were also
administered. The depressed subjects scored
significantly higher than the controls on each of
these measures at the P < 0-0001 level, with the
exception of trait obsessionality, which was
significant at the P < 0001 level.
The Vocabulary and Block Design subtests of
the WAIS-R (Wechsler, 1981) were administered
as indices of verbal and non-verbal general
ability. Mean age-scaled scores on the
Vocabulary subtest were 12-13 (S.D. 3-02) and
1305 (S.D. 2-46) for the depressed and control
groups respectively, and on the Block Design
subtest 11-50 (S.D. 2-78) and 11-90 (s.D. 311)
respectively. The groups did not differ signifi-
cantly on these measures.
Experimental measures
Articulatory loop
Phonological similarity effect This test was
adapted from the task described by Wilding &
Mohindra (1980), designed to investigate the
phonological store of the articulatory loop.
Each trial consisted of a list of 5 letters presented
on a computer screen at a rate of 1 letter per sec.
There were 2 possible letter sets, either CDGPT
(acoustically confusable) or HJMRZ (acous-
tically non-confusable), each in 12 different
random (non-meaningful) sequences. Subjects
were instructed to watch each trial presentation
carefully, and then write down the letters in
order of presentation. In addition, in half the
trials they were required to say 'one, two'
repeatedly while the letters were appearing on
the screen (suppression condition). There were
thus 4 test conditions in all, each comprising 6
trials: confusable letters with and without sup-
pression and non-confusable letters with and
without suppression. Order of presentation was
counter-balanced within groups.
Word length effect This task was adapted
from that described by Baddeley et al. (1984),
designed to investigate the length of the articu-
latory loop. Subjects listened to a tape recording
of 2 practice lists and 20 trial lists of words, each
list containing 5 short (1 syllable) or long (5
syllable) words. After each list, they were asked
to write down the words in order of presentation.
The trials were divided into 2 sets of 10, and
each set contained 5 short and 5 long trials. For
1 of the 2 sets of trials, subjects were asked to say
'one, two' repeatedly while listening to the list
and writing it down (suppression condition).
Half the subjects in each group performed in the
suppression condition for the first trial set, and
half for the second trial set. This gave 4 types of
trials: short words with and without suppression
and long words with and without suppression.
Forward digit span Span of immediate recall
of digits using digit span from the WAIS-R
(Wechsler, 1981).
Visuospatial sketch pad
Forward block sequence span Span of im-
mediate recall of spatial sequences using Corsi's
block sequence span, described by Milner (1971).
Tasks involving the central executive
Backward digit span and block sequence span
Backward recall of sequences using digit and
block sequence span (described above).
Paced and unpaced auditory serial addition test
{PASAT) This task presented a series of 31
audiotaped digits, and required subjects to add
pairs of digits so that each new digit was added
to the immediately preceding one (Gronwall &
Sampson, 1974). After practice, subjects first
performed an unpaced task, where they were
given the next digit as soon as they had given the
answer to the sum of the previous 2 digits.
Following Gotham et al. (1988), 2 paced series
were then presented, with inter-trial intervals of
4 and 2 sec respectively.
Trail-making test This test, described by Reitan
(1958), requires subjects initially to join numbers
in ascending order, and then alternate between
letters and numbers, as fast as possible.
Letter cancellation test In this task subjects
were required to cancel out visually presented
target letters which were randomly interspersed
 Working memory in depression 89

in rows of distractor letters, based on the similar pattern was found in the present study
vigilance tasks developed by Diller et al. (1974). using repeated measures analysis of variance
Identical stimuli were used for 2 conditions, (ANOVA) with one between-subjects factor
crossing out a single target ('H'), and then 2 (group) and two within-subjects factors (confus-
targets (' C 's a n d ' E 's) as fast as possible without ability, suppression). Thus, there was a sig-
errors. nificant list by suppression interaction across
groups ( F = 22-31, df = 1,42, P < 00001). Sub-
Procedure sequent analyses showed that the difference
After giving informed written consent, subjects between confusable and non-confusable lists did
were given the clinical interview; they then not reach significance in the suppression con-
carried out the experimental tasks and clinical dition, but did in the non-suppression condition
measures, with appropriate breaks between tests. (F= 59 51, df = 1,42, P < 00001). There were
Order of presentation of tests was counter- no significant two- or three-way group inter-
balanced to control for any effects of fatigue. In actions with group, nor a significant main effect
addition to these tests subjects also participated of group.
in a wordlist learning task comparing memory
for materials with different levels of structure, to Word length effect
be reported separately. Previous work reported that in normal subjects,
there was no difference between long and short
Scoring
words in the suppression condition, and a
The data for the phonological similarity effect significant difference between long and short
tasks were scored by adding the number of words in the non-suppression condition (Bad-
correct trials out of a possible 6 for each of the deley et al. 1984). In the present study, the data
4 conditions. Similarly, for the word-length task
the data were scored in terms of the number of
correct trials out of a possible 5 for each of the Table 1. Means for the depressed and control
four conditions. For the digit and block sequence groups on the experimental and self-report
spans, the score consisted of the span length of measures
digits or blocks correctly reproduced forwards
Depressed Controls
or backwards. The PASAT was scored in terms
of the number of errors made out of a possible Experimental measures Mean (s.D.) Mean (s.D.)
30 on each of the 3 tasks. For the trail-making
Phonological similarity effect
test and the letter cancellation tasks, scores were (correct trials)
the speed of performance in each condition. Confusable/suppression 1 % (1 46) 2-14(1-77)
Confusable/non-suppression 2-39(1-92) 3-24(1-51)
Non-confusable/suppression 2-48(1-78) 2-05(1-72)
RESULTS Non-confusable/non-suppression 4-78(1-54) 505(102)
Word length effect (correct trials)
The mean scores and standard deviations for the Short words/suppression 0-77(1-11) 1-38(1-36)
Short words/non-suppression 2-36(1-87) 3-19(1-60)
depressed and control groups for each measure Long words/suppression 0-64(1-18) 0-95(1-50)
are shown in Table 1. A significance level of 5 % Long words/non-suppression 1-14(1-39) 1-52(1-54)
was adopted throughout, with appropriate alpha Forward digit span 6-92(1-35) 7-33(1-20)
adjustment (alpha divided by number of tests) Backward digit span 508(1-25) 6-38(1-20)
Forward block span 5-55(101) 5-71 (101)
when post hoc tests were performed. Backward block span 5-05(1-13) 5-48(1-33)
PASAT errors
Articulatory loop 2-sec presentation 11-95(5-70) 9-25(6-91)
Phonological similarity effect 4-sec presentation 4-05 (5-42) 3-35 (482)
Unpaced presentation 5-19(5-51) 2-85(3-10)
Previous research showed that with normal
Trail-making (s)
subjects, performance on the confusable and Numbers alone 43-20 (29-56) 34-19 (12-40)
non-confusable lists did not differ significantly Numbers and letters 88-50 (7006) 69-48 (33-96)
in the suppression condition, but that there was Letter cancellation (s)
One target 60-00(12-67) 61-71 (17-60)
a significant difference between lists in the non- Two targets 115-64(24-28) 11519(26-49)
suppression condition (e.g. Murray, 1968). A
90 S. Channon and others

were transformed logarithmically to reduce and backward digit span and PASAT per-
skewness. Repeated measures ANOVA revealed formance, the experimental measures which
a significant word length by suppression in- discriminated best between the groups. There
teraction across groups (F = 5-96, df = 1,41, P were no significant correlations with the self-
< 0019). Separate analyses for the suppression report measures for either group. Nor were there
and non-suppression conditions using a strict significant associations within the depressed
significance level (alpha/2 = 0-025) showed a group with past history of depression, past
significant difference between long and short history of dysthymia, scores on the Hamilton
words in the non-suppression condition (F = Scale, or presence or absence of anti-depressant
30-77, df = 1,41, P< 00001), and a near- medication. A t test comparison of the medicated
significant difference in the suppression con- and unmedicated depressed subjects on these
dition CF = 4-65, df = 1,41, />< 0-037). There tasks showed that the groups did not differ
were no significant two- or three-way inter- significantly on either backward digit span
actions with group, nor a significant effect of (t = 008, P = 0-935) or the PASAT measures
group. (unpaced: t = 0-48, P = 0-636; 4-sec; / = 1-74,
P = 0099; 2-sec: t = 0-40, P = 0-696).
Forward digit span
The t test revealed no group difference on this DISCUSSION
measure.
The main finding was that on tasks involving
Visuospatial sketch pad aspects of working memory, clinically depressed
Forward block sequence span and control subjects did not differ on several
Again the / test revealed no group difference on measures involving the articulatory loop, or on
this measure. one measure involving the visuospatial sketch
pad. In a range of clinical tasks involving the
Tasks involving the central executive central executive, the groups differed sig-
Backward digit span and block sequence span nificantly only on backward digit span, and
Analysis by t test showed that the depressed approached a significant difference on the
subjects recalled significantly fewer digits back- PASAT, with poorer performance by the de-
wards than controls (t = 3-54, P < 0001). The pressed subjects. While it might be hypothesized
that antidepressant medication could produce
groups did not differ significantly on backward
block sequence span.
impairments in working memory, comparison
of medicated and unmedicated depressed sub-
PASAT jects in the present study did not support this
explanation.
These data were transformed logarithmically to The experimental findings were consistent
reduce skewness. Repeated measures ANOVA with the prediction based on theoretical models
comparing the groups on the three tasks, of cognitive function in depression (e.g. Ellis &
unpaced, 4-sec and 2-sec serial addition, did not Ashbrook 1988; Hertel & Hardin, 1990) that
show a significant group x task interaction; there depressed subjects should not show impairments
was a near-significant effect of group (F = 3-84, in the articulatory loop or visuospatial sketch
df= 1,39, P < 006). pad. Thus, the depressed group did not differ
significantly from normal controls on tasks
Trail-making test and letter cancellation measuring the phonological storage of infor-
Repeated measures ANOVA revealed no sig- mation (phonological similarities task), or the
nificant group x task interactions or effects of length of the rehearsal loop (word length task).
group on either of these tests. The groups also did not differ significantly on
forward digit span, which also involves the
Relationship to indices of mood articulatory loop, or on forward block sequence
Pearson product moment correlations were span, which involves the visuospatial sketch
calculated within each group to examine any pad.
relationship between the self-report measures It was also predicted that depressed subjects
 Working memory in depression
might be expected to show impairment on tasks
involving the central executive, and there was
some evidence for this. The depressed subjects
did show impairment on backward digit span,
which requires the manipulation of sequences in
the central executive in addition to temporary
storage. Warren & Groome (1984) reported
similar findings in clinically depressed subjects
before ECT, with no impairment on forward
digit span and marginal impairment on back-
ward span. The near-significant difference be-
tween the groups on the PASAT tasks in the
current study is also consistent with expecta-
tions, since this involves the temporary storage
of a sequence of numbers in the articulatory
loop, and serial addition of consecutive pairs of
these numbers in the central executive. However,
the depressed subjects were unimpaired on
several other measures likely to involve the
central executive, namely backward block se-
quence span, the trail making test, and letter
cancellation.
According to the models which postulate
deficient attentional resources (e.g. Ellis &
Ashbrook, 1988; Hertel & Hardin, 1990), de-
pressive deficits should occur maximally on
tasks which make high demands on attentional
resources, or where performance can be im-
proved by active encoding strategies. It may be
that the pattern of findings in the present study
reflects the differential sensitivity of the various
clinical tasks to any reduction of available
processing resources in the central executive.
However, any post-hoc explanations on this
basis can only be speculative in nature. Alterna-
tively, an explanation might be sought in terms
of multiple processing resources (e.g. Wickens,
1984; Navon, 1987), with the various tasks
drawing on specialized processing resources to
differing extents.
Overall, the current findings suggest that any
effects of clinical depression on working memory
are likely to spare the articulatory loop and
visuospatial sketch pad. The evidence for im-
pairment of the central executive was patchy,
and further studies are needed which system-
atically explore the effects of varying the
demands on central executive function.
This study was funded by the North East Thames
Locally Organized Research Scheme.
91
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